| NPI | 1295345924 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: TX 36491) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 36491) |
| Enumeration Date | 2020-08-07 |
| Last Update Date | 2024-09-13 |